Provider First Line Business Practice Location Address:
1319 N FRANKLIN ST APT 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122-4364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-424-8947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2025